Catheter-related bloodstream infection due to Rhodotorula mucilaginosa with normal serum (1→3)-ß-D-glucan level.

Rhodotorula species are environmental basidiomycete yeasts that have emerged as a cause of fungemia in immunocompromised hosts. The insertion of a central venous catheter was identified as a major risk factor for Rhodotorula fungemia. Few cases reports have reported (1→3)-ß-D-glucan testing at the onset of Rhodotorula mucilaginosa fungemia. We report a case of catheter-related bloodstream infection due to R. mucilaginosa. Serum ß-D-glucan level was normal at the onset of the bloodstream infection. It took 5 days to culture the isolate. The patient's fever persisted after empiric treatment with micafungin, and a switch to oral voriconazole immediately resolved the fungemia.

Evaluation of genetic factors involved in nocturnal electromyographic activity of masticatory muscles in twins.

OBJECTIVES: The objectives of this study were to assess sleep bruxism events by directly recording electromyographic activity during sleep and to reveal the relative importance of genetic and environmental factors involved in sleep bruxism in twins. MATERIAL AND METHODS: The subjects consisted of 108 twins (mean age 22.2 ± 6.4 years). Electromyographic activity of temporalis muscles during sleep was evaluated using a portable automatic sleep bruxism analyzer (Grindcare 3.0, Medotech A/S), and recordings were carried out for at least three consecutive nights. Quantitative genetic statistics based on structural equation modeling was utilized to estimate variance components. RESULTS: Monozygotic twin-pair correlation for the number of nocturnal electromyographic activities recorded in this study (r = 0.463, P = 0.009) was higher than dizygotic twin-pair correlation (r = 0.103, P = 0.725). The proportion of total phenotypic variance in the liability of sleep bruxism to attribute to genetic influences, related to the electromyographic activities, was 48 % (95 % CI 17-95 %) and to unique environmental influences was 52 % (95 % CI 28-82 %). CONCLUSIONS: Additive genetic effects may be a contributing factor to the occurrence of nocturnal EMG activity associated with sleep bruxism. CLINICAL RELEVANCE: A greater understanding of the contribution of genetic factors could have beneficial uses, including enhanced accuracy of sleep bruxism diagnosis, management of sleep bruxism, and enhanced estimation of the prognosis for patients suffering from sleep bruxism. In addition, it could be also important to adequately evaluate the environmental factors in patients with sleep bruxism.

Clinical significance of dual-energy CT-derived iodine quantification in the diagnosis of metastatic LN in colorectal cancer.

BACKGROUND: The purpose of this study was to evaluate the diagnostic value of dual-energy computed tomography (DECT) in detecting lymph node (LN) metastasis in patients with colorectal cancer. METHODS: Data from 81 LNs from 28 patients with colorectal adenocarcinoma were retrospectively analyzed. All patients received DECT before surgery without any neoadjuvant therapy. The diagnostic value was assessed using the iodine concentration (IC). RESULTS: In the pathological findings, 35 (43.2%) LNs from 13 patients were metastatic and 46 (56.8%) LNs from 17 patients were non-metastatic. The mean IC of metastatic LNs in the portal venous phase (PP) was 1.60 mg/ml, which was significantly lower compared with non-metastatic LNs (3.25 mg/ml, p < 0.001). Receiver operating characteristic (ROC) analysis revealed that the IC in PP had the highest ability to discriminate LN metastasis (area under the ROC curve [AUC] 0.932). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of IC in PP (cutoff 2.1 mg/ml) were 87.0%, 88.6%, 85.3%, 90.0%, and 87.9%, respectively. When clinically obvious metastatic LNs in conventional CT findings were excluded, 50 LNs remained (5 metastatic and 45 non-metastatic LNs). In this subgroup analysis, the IC in PP remained the most powerful predictor of metastatic LNs (cutoff: 2.1 mg/ml, AUC 0.933). CONCLUSIONS: The evaluation of IC in DECT may improve the diagnostic capabilities of discriminating metastatic LNs. This method may be particularly useful when conventional CT findings lead to equivocal results.

Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma.

BACKGROUND AND STUDY AIMS: Growing evidence suggests that esophageal stricture frequently develops after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in early esophageal cancer patients, with an incidence proportional to the greater extent of mucosal defects resulting from improved EMR/ESD techniques. There seems to be a potential risk of perforation during bougienage in such patients. PATIENTS AND METHODS: 648 stricture dilations for 78 lesions in 76 patients were consecutively included. The outcomes after combined use of Maloney and Savary wire-guided bougienage for esophageal strictures after EMR/ESD were analyzed in a single-institute retrospective case series study. The perforation rate was determined and risk factors for perforation were identified. RESULTS: Patients underwent a median of 5.0 dilation procedures performed over a median 3.0 months for post-EMR/ESD strictures. Initial dilation was done a median 14 days following endoscopic resection. Perforations developed in seven patients (7/648 dilation procedures, 1.1%), all in the lower esophagus, and bleeding occurred in one patient (0.1% dilations). Two independent risk factors for development of perforation during dilation therapy for post-EMR/ESD stricture were identified: multiple dilations (odds ratio [OR] 1.2; P=0.012), and lower site of stricture (OR 12.8; P=0.043). Dysphagia was ameliorated by the dilations, and no patient required surgery. CONCLUSIONS: A specific emerging risk of perforation in dilation therapy for post-EMR/ESD strictures was identified. Carefully planned treatment is necessary in patients with severe post-EMR/ESD strictures especially strictures requiring multiple dilations or located in the lower esophagus.

Mean power frequency during speech in myalgia patients.

The purpose of this study was to clarify a difference of mean power frequency (MPF) during speech between control and myalgia patients groups. The control group consisted of 20 asymptomatic volunteers and the myalgia patients group consisted of 19 patients. A bilateral electromyogram (EMG) of masseter muscles during speech movement was recorded using surface electrodes, and the EMG data were stored and analysed with a computer-based EMG analyzer. The MPF during the entire duration of EMG burst during speech was compared between the control and myalgia group. The average (SD) MPFs during speech in the myalgia and control groups were 214.06 (17.23) and 183.39 (22.35) Hz, respectively, significantly higher in the former (P < 0.001). In myalgia patients, firing rates or recruitment of motor units innervated by high threshold motoneurons might decrease and lead to a higher MPF. The result suggests the possibility that muscle pain, that is a subjective experience, could be evaluated by objective data that is calculated from electromyographic activities which is recorded during speech.

AATF mediates an antiapoptotic effect of the unfolded protein response through transcriptional regulation of AKT1.

Endoplasmic reticulum (ER) stress-mediated cell death has an important role in the pathogenesis of chronic diseases, including diabetes and neurodegeneration. Although proapoptotic programs activated by ER stress have been extensively studied, identification and characterization of antiapoptotic programs that counteract ER stress are currently incomplete. Through the gene expression profiling of beta-cells lacking Wolfram syndrome 1 gene (WFS1), a causative gene for Wolfram syndrome, we discovered a novel antiapoptotic gene of the unfolded protein response (UPR), apoptosis antagonizing transcription factor (AATF). Here, we study the regulation of AATF, identify its target genes, and determine the basis for its antiapoptotic activities in response to ER stress. We show that AATF is induced by ER stress through the PERK-eIF2alpha pathway and transcriptionally activates the v-akt murine thymoma viral oncogene homolog 1 (AKT1) gene through signal transducer and activator of transcription 3 (Stat3), which sustains Akt1 activation and promotes cell survival. Ectopic expression of AATF or a constitutively active form of AKT1 confers on cells resistance to ER stress-mediated cell death, whereas RNAi-mediated knockdown of AATF or AKT1 renders cells sensitive to ER stress. We also discovered a positive crosstalk between the AATF and WFS1 signaling pathways. Thus, WFS1 deficiency or AATF deficiency mediates a self-perpetuating cycle of cell death. Our results reveal a novel antiapoptotic program relevant to the treatment of diseases caused by ER stress-mediated cell death.

Three-dimensional CT angiography of the pancreatic artery in 16-channel multislice CT: value of scanning with submillimetre collimation.

The aim of this study was to assess the effects of the reconstructed thickness of axial images on image quality of CT pancreatic arteriography with 16-channel multislice CT. In 31 consecutive patients, raw data of arterial-phase scanning with 0.5 mm collimation were reconstructed in the following three ways: 0.5 mm thickness (effective thickness of 0.75 mm) at 0.4 mm intervals in Group 1; 1 mm thickness at 0.5 mm intervals in Group 2; and 2 mm thickness at 1 mm intervals in Group 3. For the visualization of major arteries and small arteries of the pancreatic head, four blinded readers independently performed side-by-side comparison of the CT arteriographic images generated from each axial dataset for the same patient using a three-dimensional volume-rendered technique. In all comparisons using a continuous rating scale, CT arteriographic images generated from thinner axial images were found to be significantly superior (p<0.01). The difference was more pronounced for small arteries. The degree of degradation from Group 1 to Group 2 was markedly smaller than that from Group 1 to Group 3 or from Group 2 to Group 3. For small arteries, paired images were assigned a grade of "almost equivalent" in 73%, 6% and 15% of the comparison between Group 1 and Group 2, Group 1 and Group 3, and Group 2 and Group 3, respectively. We concluded that the image quality of CT pancreatic arteriography, especially for small arteries, can be improved by reconstructing axial images with thinner thickness from the data obtained with submillimetre collimation.

Occlusal interference during mastication can cause pathological tooth mobility.

BACKGROUND AND OBJECTIVE: Despite little evidence regarding the relationship between tooth mobility and nonworking contact, the evaluation of occlusion is performed mainly by the detection of premature and/or nonworking contacts during tapping movements and lateral excursion. The hypothesis of this study is that occlusal contact during mastication is potentially traumatic to periodontal tissue. It clarifies the relationship between chewing patterns and the status of periodontal tissue. MATERIAL AND METHODS: Subjects included 73 adults, 20-29 years of age (39 men and 34 women), with complete sets of teeth and no history of orthodontic treatment or periodontal disease. The closing chewing patterns of each subject were classified into three groups by the Masticatory Deviation Index, which depicts the deviation from the normal chewing patterns within 5 mm from the intercuspal position. Periotest was used to diagnose teeth mobility and the values were compared among the three groups. RESULTS: The present study indicates that the chewing movements which deviated from the normal chewing movements increased the mobility of specific types of teeth. CONCLUSION: The results of this study imply a relationship between chewing movements and tooth mobility and indicate that functional evaluation of occlusion is necessary for the examination of periodontal tissue. Occlusal evaluation with border and tapping movements might be insufficient, and functional occlusal evaluation during chewing movements can be clinically useful for using to evaluate periodontal tissue.

Influence of abutment substrates on the colour of metal-free polymer crowns.

New-generation composite materials have excellent strength and wear resistance, and thus can be used to make metal-free crowns. However, composite materials are translucent, and so when using them to make metal-free crowns, it is necessary to take the effect of the abutments into consideration. In this study, five types of materials including three types of new-generation composite materials, a conventional composite material, and a ceramic material were used to examine the translucency (contrast ratio) of the materials and the effects of the colour of the abutments on the final appearance of metal-free crowns. It was found that the materials varied slightly from one-another in translucency and that it was possible to reproduce the desired colour when gold alloy was used for the background. However, it was difficult to produce an adequate colour match when silver-palladium alloy was used for the background. When a tooth colour material that was darker than the target colour was used for the abutment teeth, some materials could not reproduce the target colour satisfactorily.

Fracture resistance of pressable glass-ceramic fixed partial dentures.

The aim of the present study was to evaluate the mechanical strength of the Empress2 system, which is based on the use of a high-strength glass--ceramic core of lithium disilicate, and the fracture resistance of fixed partial dentures fabricated with this material. To evaluate mechanical strength, four types of ceramic materials were tested for four-point flexural strength and diametral tensile strength: Empress2 core material, Empress2 layering porcelain, conventional Empress material and Dicor. Then, using Empress2, conventional Empress and Dicor, actual clinical type anterior fixed partial dentures were fabricated for fracture testing. The results showed that the Empress2 core material, at 329 MPa, has more than twice the flexural strength of conventional materials and at 271 MPa, more than four times the diametral tensile strength of conventional materials. Furthermore, fixed partial dentures fabricated with Empress2 had a fracture resistance of 1424 N. That is, they were more than twice as fracture resistant as fixed partial dentures made with conventional materials.

Influence of abutment substrate and ceramic thickness on the colour of heat-pressed ceramic crowns.

All-ceramic crowns made of leucite-based heat-pressed ceramics are widely used to restore non-vital teeth in conjunction with various post and core materials. However, as some light passes through the ceramic, the colour of the abutment substrate can negatively affect the final aesthetic appearance of the all-ceramic crown. In this study, we made background specimens simulating gold-alloy cast posts and other simulating porcelain veneered cast posts, overlaid different thickness of heat-pressed ceramic on these background specimens, and measured the shifts in colour. We found that, when the background specimen was a gold alloy, the background colour had an effect on the apparent colour, unless the ceramic was more than 1.6 mm thick. When the background specimen was porcelain veneered, the background colour had no evident effect, even when the ceramic was not very thick. Therefore, when making a restoration using a leucite-based heat-pressed ceramic crown, it is advisable to use tooth-coloured materials such as a porcelain veneered cast post, if you will not be able to make the ceramic more than 1.6 mm thick.

A novel centrosomal ring-finger protein, dorfin, mediates ubiquitin ligase activity.

We cloned a novel gene, Dorfin (double ring-finger protein), from human spinal cord. The Dorfin mRNA transcript was 4.4 kb and expressed ubiquitously in many organs as well as in the central nervous system, including the spinal cord. Dorfin encoded 838 amino acid protein Dorfin, which contains two RING-finger motifs and an IBR (in between RING-fingers) motif at its N-terminus. Dorfin is a short-lived protein. Treatment with MG132, a potent proteasome inhibitor, resulted in the accumulation of ubiquitinated Dorfin and Dorfin-associated cellular proteins in cultured cells. Dorfin bound specifically with human ubiquitin-conjugating enzymes UbcH7 and UbcH8 through the RING-finger/IBR domain. Partial deletion of the RING-finger/IBR domain eliminated these interaction and ubiquitination activities. These results strongly suggest that Dorfin is a new member of RING-finger type ubiquitin ligase. Dorfin is localized in the centrosome and probably functions in the microtubule organizing centers.

Stress analysis of metal-free polymer crowns using the three-dimensional finite element method.

PURPOSE: The purpose of this study was to evaluate the stress distribution under various loading conditions within posterior metal-free crowns made of new composite materials. MATERIALS AND METHODS: A three-dimensional finite element model representing a mandibular first molar was constructed. Variations of the model had crowns of two types of composite, a glass ceramic, and porcelain fused to metal. A load of 600 N, simulating the maximum bite force, was applied vertically to the crowns. Loads of 225 N, simulating masticatory force, were applied from three directions (vertically, at a 45-degree angle, and horizontally). RESULTS: The stress distributions in both types of composite crown were similar to that of the glass-ceramic crown. In the test simulating maximum bite force, the maximum tensile stresses on all crowns (17.9 to 18.3 MPa) concentrated around the loading points. In the masticatory force-stimulation test, the specimens experienced maximum tensile stresses of 20.3 to 26.6 MPa under a horizontal load and 10.9 to 11.0 MPa under a vertical load. When the load was applied horizontally, the maximum tensile stress was observed around the loading points on the surface in the case of composite and glass-ceramic crowns, and in the cervical area of the metal coping in the porcelain-fused-to-metal crowns. CONCLUSION: It would appear that the strength of occlusal contact points is important to the integrity of posterior metal-free crowns made of new composite materials and that bite forces applied from the horizontal direction are a critical factor determining success and failure.

Two novel genes, human neugrin and mouse m-neugrin, are upregulated with neuronal differentiation in neuroblastoma cells.

We herein report two new genes, human neugrin and mouse homologue m-neugrin, found by screening the cDNA library for the human spinal cord. The neugrin mRNA encodes 219 amino acids and its deduced amino acid sequence contains an NLS-like domain. No previously known motif is found in it. m-neugrin mRNA encodes 233 amino acids. Neugrin and m-Neugrin are 70% homologous in amino acid sequence. Northern analysis revealed that neugrin was strongly expressed in the heart, brain, and skeletal muscle, and m-neugrin in the liver, kidney, and brain. A transfection study indicated that these proteins are localized in the nucleus. Although the expression of neugrin was found to be ubiquitous in the nervous system, in situ hybridization showed that both neugrin and m-neugrin were expressed mainly in the neurons rather than the glial cells. Their expression was highly upregulated with the neurite outgrowth associated with neuronal differentiation in neuroblastoma cell lines. These results indicate that neugrin and m-neugrin are mainly expressed in neurons in the nervous system, and play an important role in the process of neuronal differentiation.

[Pure red cell aplasia induced by clomipramine hydrochloride in a patient with SLE].

A 48-year-old woman, who had been suffering from systemic lupus erythematosus (SLE), developed normochromic normocytic anemia after receiving clomipramine hydrochloride. Her reticulocyte count was low, and a bone marrow aspirate revealed erythroid hypoplasia without involvement of other cell lines. Thus a diagnosis of pure red cell aplasia (PRCA) was made. The anemia gradually resolved following withdrawal of the drug. Although several drugs are known to cause PRCA, this is the first time that clomipramine hydrochloride has been reported to have such an effect. The underlying SLE in this case suggested the possible immunological pathogenesis of drug-induced PRCA.

The mouse L-histidine decarboxylase gene: structure and transcriptional regulation by CpG methylation in the promoter region.

To investigate the regulation of mouse L-histidine decarboxylase (HDC) gene expression, we isolated genomic DNA clones encoding HDC. Structural analysis revealed that the mouse HDC gene was composed of 12 exons, spanning approximately 24 kb. Northern blotting analysis indicated that, among the cell lines examined, a high level of HDC gene expression was restricted to mature mast cell lines and an erythroblastic cell line. The gene was induced strongly in the mouse immature mast cell line P815 after incubation in the peritoneal cavity of BDF1 mice. We observed that the promoter region was demethylated in the HDC-expressing cell lines and in induced P815 cells. Interestingly, forced demethylation by 5-azacytidine (5-azaC) treatment induced high expression of HDC mRNA in P815 cells. The activity of a mouse HDC promoter-reporter construct stably transfected in P815 cells was repressed by in vitro patch-methylation. This low promoter activity of the patch-methylated reporter construct was restored after 5-azaC treatment, which demethylated the patch-methylated promoter. These results indicate that DNA methylation state of the promoter region controls HDC gene expression.

[Evaluation of a new method for antifungal drugs susceptibility testing to yeasts].

We compared the Etest with a broth microdilution method (FP panel), performed according to the National Committee for modified Clinical Laboratory Standards (NCCLS) document M27-P guidelines, for determining the MICs of 81 clinical isolates of yeasts (7 Candida albicans, 8 Candida glabrata, 10 Candida parapsilosis, 6 Pichia anomala, 10 Candida tropicalis, 4 Candida guilliermondii, 4 Candida krusei, 6 Trichosporon cutaneum, 5 Candida ciferrii, 3 Candida famata, 4 Candida norvegensis, 2 Rhodotorula rubra, 3 Candida lusitaniae, 2 Candida curvata, 1 Candida inconspicua, 1 Candida intermedia, 1 Candida colliculosa, 1 Cryptococcus spp, 1 Tricosporon capitatum, 1 Pichia ohmeri, 1 Saccharomyces cerevisiae). The Etest results for 6 ATCC standard strains correlated well with reference MICs except those of flucytosine (5-FC) for C. krusei, which tended to be 1 to 2 log2 dilution higher than the MIC range determined by NCCLS guidelines. However, the best agreement between the results for clinical isolates was seen with 5-FC (100% agreement [Within +/- 2 log2 dilutions] between the results of the two methods). There was a 91.4% agreement between the results of the two methods with amphotericin B (Etest MICs tended to be 1 to 2 log2 dilution lower than those of the FP panel). The Etest results with litraconazole for clinical isolates except C. tropicalis were similar to MICs of the FP panel (Etest for C. tropicalis showed 1 to 2 log2 dilution lower than FP panel). Also, the Etest results with fluconazole for clinical isolates except C. tropicalis were similar of 1 log2 dilution higher than MICs of the FP panel (Etest for C. tropicalis showed more than 2 log2 dilution lower than FP panel). These results showed a good level of overall agreement between the Etest method and the broth microdilution test (FP panel). Since the Etest is a less laborintensive and much simpler method, it appears to be a useful procedure for testing the susceptibility of yeasts to antifungal agents.

Significance of membrane type 1 matrix metalloproteinase expression in breast cancer.

Expression of matrix metalloproteinases (MMPs) plays an essential role in tumor metastasis and invasion through the degradation of extracellular matrix (ECM). MT1-MMP (membrane type 1 matrix metalloproteinase), a membrane-type MMP, is responsible for the activation of MMP2. In this study the significance of MT1-MMP expression in human breast tumors was investigated by immunocytochemical assay, and its correlation with clinicobiological features was analyzed. MT1-MMP expression was detected in tumor cells and/or stromal cells, and there was a strong correlation between the expressions of MT1-MMP in the two cell types. Out of 183 primary tumors, 103 (56.2%) showed positive staining of MT1-MMP in tumor cells. MT1-MMP expression showed no significant correlation with any of the clinicobiological parameters examined, including hormone receptor status and angiogenesis. In postoperative survival analysis, MT1-MMP expression itself was not a significant prognostic factor. However, in the particular subgroup with the accumulation of thymidine phosphorylase (TP)-positive stromal cells, which have been activated by various stimuli, such as cytokines and hypoxia, MT1-MMP expression had a significant prognostic value. These data suggested that MT1-MMP might function cooperatively with tumor-associated stromal cells for the progression of breast cancer.